Emphysema

X-ray diagnostics. X-ray semiotics of emphysema are very diverse and reflects certain pathomorphological and pathophysiological changes in the different stages of this disease. Currently, the majority of authors divides all x-ray symptoms of emphysema on morphological and functional.
Rentgenograficheskie symptoms that reflect changes shapes and sizes difficult cells, are secondary and usually indicate advanced phase currents of emphysema. The most common symptom of severe emphysema is the so-called barrel deformation of the chest (Fig. 3), is especially clearly revealed in the study of lateral projection due to predominant increase anteroposterior size, i.e. the distance between the breastbone and the spine. This is facilitated by three factors: a more horizontal than normal, the location of ribs, kyphosis of the thoracic spine and vastanie sternum to the front. Vastanie sternum is a frequent and important symptom of emphysema is usually combined with other essential sign - extension anterior mediastinum and increased its transparency ("hiatus" anterior mediastinum). While the side projections have noted a marked increase in the distance between the breastbone, on the one hand, and the shadow of the heart and main vessels on the other. This is the result of otodvigala heart and large vessels backwards advanced front lungs.
In front of a projection may be noticeable symmetric protrusion of the lower divisions of the chest, over which pronounced in cases of emphysema form a kind of "waist", resulting in the chest takes the form of a bell or hourglass (Fig. 4).
Rentgenograficheskie symptoms are observed also on the part of the lungs. Along with the General increase in the area of the lung fields (mainly due to the expansion of the vertical dimensions) and diffuse transparency can to find local areas increasing transparency through the formation of multiple large emphysematous bull, local emphysema, or acute abdominal separate areas of the lung (the share of the segment). These local areas enlightenment observed more often in the basal regions of the lung fields are of great diagnostic value.
The majority of authors considers typical for emphysema changes in lung picture - it redundancy, sometimes deformation, because emphysema is usually combined with pnevmaticheskie changes. Some authors believe redundancy pulmonary pattern consequence peritonialnogo and perivascular pneumosclerosis, others the result of increasing the contrast of vascular shadows on the background of increased pneumatization easy, others the result of the stagnation of blood in the blood vessels resulting in narrowing of the capillary bed of the small circle of blood circulation. Apparently, there are all these factors both in themselves and in their mutual combinations.
When emphysema changes and aperture. The dome it is below normal, flattens, and in rare cases may even slightly bend down. Rib-diaphragmatic sinuses are expanding. In severe cases of emphysema diaphragm cupola takes the form of tents or pointed roofs, with the top of which merges the so-called shadow hanging, at the centrally located, the small size of the heart (Fig. 5).
The most important roentgenologically symptom emphysema lung disorders pulmonary ventilation - associated with the loss of elasticity of the lung tissue and reduction in lung capacity (VC).
X-ray density (transparency lung fields) normal lung significantly changed in connection with phases of breathing. During inhalation, there is a significant enlightenment lungs compared to exhale. This difference is particularly well visible in the basal lungs taking a more active part in the process of pulmonary ventilation in comparison with other departments. When emphysema this gap to some extent reduced, and in severe cases almost completely disappears. These changes the transparency of the lungs when the maximum you inhale and exhale radiographically appears YELLOW.
The most simple and effective way radiographic evaluation of pulmonary ventilation at the x-raying is the limitation created by stopping down on the x-ray screen lung area above the right diaphragm cupola approximately Hu cm so that in the lower third of this vertical rectangle, was the edge of the dome of the diaphragm, which allows to monitor respiratory excursions diaphragm.
Emphysema of the lung along with the reduction of differences in the transparency of the lungs with a deep breath indicates a significant decrease in the amplitude of the movements of the diaphragm, which in severe cases of emphysema can be perfectly still, and sometimes to make paradoxical motion (with a deep breath - up) in connection with movements up front parts of the ribs.
For radiographic registration violations of pulmonary ventilation with emphysema Yu. N. Sokolov offer the following way (Fig. 6). On a small film (h H cm) is made by means of a tunnel cassette series of three shots under the same conditions exposition, but in different phases of respiratory: respiratory pause, maximum breath, maximum exhale.
In a healthy person, there is a notable difference in the photographic density between all three images (especially between inhalation and exhalation). When emphysema this difference decreases sharply, and in severe cases, almost disappears.
Recognition of emphysema with rentgenografii and electrotomography also based on identifying roentgenologically symptoms that reflect violations of pulmonary respiration and circulation.

Fig. 3. Chronic emphysema; typical barrel deformation of the chest. Kyphosis of the thoracic spine. Pronounced vastanie sternum anteriorly and "hiatus" anterior mediastinum.
Fig. 4. Severe chronic emphysema, chest hourglass.
Fig. 5. Severe chronic emphysema. The area of the lung fields increased mainly due to the vertical dimension. Low position of the diaphragm; the dome it has the form of a tent. In the right lung - picture limited basal pneumosclerosis and dense Magdalena of commissure.
Fig. 6. Test for pulmonary ventilation method aligned serial pictures (negative): 1 - basal Department right lung healthy person with a normal VC (4200 ml); 2 - basal Department right lung patient with chronic emphysema (VC 2100 ml). The photo on the right is a moment of breathing pauses; middle - extremely deep breath; left - deep exhale. Squares circled the field of x-rays subjected photometry for a more precise definition of photographic density.